I respectfully disagree. A simple experiment can be done to find out the difference in the pressure that is exerted by the Doyen forceps to the bowel. Take a piece of paper towel and fold it 3 times. Grasp the folded paper towel by the tip of the Doyen clamp using one click and then try to pull the stripe of the paper towel while holding the doyen steady. Remember the amount of force that you exerted (or use a dynamometer for more accurate results). Then, repeat the same experiment but this time hold the same piece of paper towel by the middle of the clamp and try to pull the paper towel. What is the difference in the force that you exerted this time? And some physics now: The force F that you apply to pull the paper towel is equal to the friction Fr between paper towel and the forceps and the Friction is given by the product of the force f applied to the paper towel by the forceps multiplied by the coefficient of friction: Fr=f x c. So, F=Fr=f x c. Thus, the force F that you apply to pull the paper towel is proportional to the force f applied to the paper towel by the forceps.
@focusandflourish5168
10 ай бұрын
Thank you for your comment! I have to admit that I have not done any experiments or calculated the coefficient of friction so I will defer to your expertise on that. I base my comment on years of teaching and seeing how the bowel looks when placed in the centre of the Doyens for a period of time. Not pretty.
@vangelispapachristos2599
10 ай бұрын
@@focusandflourish5168 I hope that you have done the simple experiment that I describe. Based on what I have said the effect (impression, dimple) on the intestine must be worse when the Doyen is placed with its distal portion on the intestine. Actually the Doyen its not gentle on the intestine wherever you apply it! The best intestinal clamp are the fingers of a sterile assistant. But in lieu of an assistant, as its usually my case, then an Allis tissue forceps with added rubber tubes on one or both jaws can do the trick. Even a hairpin can do the magic in tiny patients.
@focusandflourish5168
10 ай бұрын
On that we can agree, doyens are not completely atraumatic and, one should strive to remove them as quickly as feasible. A sterile assistant is for sure an excellent choice if one is available.
@vangelispapachristos2599
10 ай бұрын
Here is a thing I've observed. Your Doyen forceps have way more elastic jaws than mine and have a larger gap between them (as far as I can see in the video) then mine. So, more parameters are introduced into the equation ie the gap and the elasticity of the jaws. If the bowel thickness is less then the gap of your forceps eg in a small patient and you apply the middle of the jaws on the bowel, then the pressure on the bowel may be 0 or very low. If apply your forceps with the tip on a bowel of small thickness, then the pressure on the bowel would be much larger. But what if the thickness of the bowel is larger then the gap and you apply the tip or the middle of the jaws on the bowel? What if using a much more sturdy Doyen like mine? An experimental study with cadaver intestines of various diameters with different Doyens would be very useful. For compering my Doyen with yours the execution of the experiment with the folded paper towel that I describe in my first comment could be done.
@focusandflourish5168
10 ай бұрын
Hello and my apologies for taking so long to respond; I was away but, now I am back ;) Your comments are very interesting. Clearly you have a sharp, analytical and inquisitive mind. You like to think up ways of proving or disproving a theory or a point; very scientific. I am definitely more clinically oriented; although I do like to read the scientific studies and see what directions we are trending in; I take more pleasure in reading a well designed clinical study with an adequate power that can help me make better decisions in the OR and for my patient in general. I have several sets of doyens, they are of varying stiffness and quality; as you have described above. I prefer using the ones that have more flexibility as my perception is that they are less traumatic to the tissues. But are they? These less stiff ones do tend to slip off smaller diameter bowel more readily (although not that often) but since most of the bowel work is done outside of the abdomen it doesn't really worry me. The study you described would be interesting to determine if my perception is correct or erroneous. The results would likely satisfy the analytic and curious component of my brain; but I would still want to know if the results are clinically significant and relevant to the patient.
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